卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染，给予头孢唑肟钠（2.25 g静脉滴注，1次/d）、卡马西平（0.2 g口服，2次/d）、尼美舒利（100 mg口服，2次/d）、二羟丙茶碱（0.5 g静脉滴注，1次/d）、甲钴胺（0.5 mg口服，3次/d）、地塞米松（5 mg，静脉滴注1次）、盐酸哌替啶（25 mg，肌内注射1次）和盐酸布桂嗪（100 mg，肌内注射3次）等药物治疗。第7天，停用头孢唑肟钠，改为磷霉素钠（8 g静脉滴注，1次/d）。第11天，血常规检查示白细胞计数1.6×10^9/L，中性粒细胞0.03，中性粒细胞绝对值0.1×10^9/L，淋巴细胞绝对值0.9×10^9/L。立即停用所有药物，给予对症支持治疗。第15天，外周血白细胞计数0.9×10^9/L，中性粒细胞0.02，中性粒细胞绝对值0.1×10^9/L，淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查，诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染，经抢救无效死亡。

Agranulocytosis associated with carbamazepine combined with nimesulide

A 78-year-old man received intravenous infusion of ceftizoxime sodium 2. 25 g once daily,oral carbamazepine 0. 2 g twice daily,oral nimesulide 100 mg twice daily,intravenous infusion of dihydroxypropyl theophylline 0. 5 g once daily,oral mecobalamin 0. 5 mg thrice daily,intravenous infusion of dexamethasone 5 mg for one time,intramuscular injection of meperidine hydrochloride 25 mg for one time, and intramuscular injection of bucinnazine hydrochloride 100 mg for three times for postherpetic neuralgia and chronic obstructive pulmonary diseases with infection. On day 7,ceftizoxime sodium was stopped and changed to intravenous infusion of fosfomycin sodium 8 g once daily. On day 11, his blood routine examination showed the following levels：white blood cell count 1. 6 × 10^9/L with neutrophils 0. 03,neutrophil absolute count 0. 1 × 10^9/L,and lymphocyte absolute count 0. 9 × 10^9/L. All the drugs were discontinued and symptomatic and supportive treatment was given. On day 15,the level of white blood cell became 0. 9 × 10^9/L with neutrophils 0. 02,a absolute value of neutrophil and lymphocyte were respectively 0. 1 × 10^9/L and 0. 7 × 10^9/L. According to bone marrow smear histology,agranulocytosis was diagnosed. On day 17, the patient developed pneumothorax and atelectasis in the right lung. On day 20,acute respiratory failure and multiple organ failure occurred with infection and the resuscitation was unsuccessful.